Type 2 Diabetes

Patient's lab values for BUN and Creatinine are both elevated meaning kidneys are not working the best.

INSULIN RESISTANCE The body doesn't create enough insulin or the liver, fat, and muscle don't respond to the little insulin being made

When the insulin isn't being used correctly it is left in the bloodstream and isn't used as fuel for energy

The beta cells begin to work excessively so that more insulin could be produced, allowing cells to take in glucose

As insulin secretion increases beta cells become exhausted which leads to insulin deficiency

As the exhaustion off the beta cells continue they began to deteriorate until the production of insulin is ceased

Risk Factors

Prediabetes
Overweight
45 years or older
Genetics
Inactive
Gestational diabetes
Elevated HgA1/C

Insulin resistance elevates levels of free fatty acids in plasma, leading to decreased glucose transport into muscle cells, elevated hepatic glucose production, and increased breakdown of fat.

Beta cells don't recognize high blood glucose which leads to decreased insulin secretion

Insulin resistance combined with the presence of lipid and thrombotic abnormalities and atherosclerotic risk factors determines cardiovascular risk; increased cardiovascular risk begins before hyperglycemia, possibly because of insulin resistance.

Beta-Cells compensate to restore glucose hemostasis

Glucotoxicity: high level of sugar build up in the blood

Abnormal glucose tolerance occurs, and postprandial blood glucose levels increase; hepatic gluconeogenesis suppression fails, and fasting hyperglycemia develops.

Diabetic Foot Ulcer (evident from assessment findings on George)

High blood sugar can result in damage to blood vessels.

Diabetes and Hypertension

Diabetes damages the small blood vessels, causing the walls to stiffen and function improperly

Diabetes causing scarring in the kidneys through long time improper diet from damage to blood vessels and damage to nephrons through sugar levels also allowing protein to pass through urine

High levels of glucose in the blood can possibly result in plaque buildup.

Leads to salt and water retention, raising blood pressure

This plaque buildup can make it extremely difficult for blood to pump properly.

These changes lead to high blood pressure by not letting the vessels constrict or dilate as they need to

Which can put the patient at 50% more risk of developing open angled glaucoma from optic nerve changes (George already has been diagnosed with Open Angle Glaucoma)

Overtime, this bloodflow issue can result in damage to small blood vessels that are responsible for supplying nerves in the body.

Consistent missed blood glucose testing coupled with lack of appropriate insulin administration

Consistently high blood glucoses leading to elevated HgA1/Cs leading to worsened physiological responses.

Neuropathic pain associated to decreased circulation of blood to extremities (legs and feet), eyes, and urinary system.

Decreased CV function to extremities due to improper management of circulating blood glucose

Urinary Issues including polyuria, nocturia, and impaired renal function arising from excessive hyperglycemia.

Multifactorial complication of unmanaged Diabetes with factors such as poor glycemic control, underlying neuropathy, poor foot care, and contraction of opportunistic infections. Affects roughly 15-25% of diabetic patients. (Evident from assessment findings on George)

Condition is chronic in patients with complications of underlying illness

One of the most common precursors for osteomyelitis and foot amputation in lower extremities

This condition is typically treated with combined intervention of multiple physicians including podiatrists, vascular surgeons, endocrinologists, and infectious disease specialists.

Patient's HgA1/C is an 8 meaning their blood glucose level is around 183 mg/dL

Patient claims to use the restroom up to 10 times at night

Patient's lab values for BUN and Creatinine are both elevated meaning kidneys are not working the best.

Patient's BP is 165/95 with an elevated heart rate(92) which is indicative of diabetes related heart issues

Patient's fasting blood sugar test is132 mg/dL

More likely to have UTI's from the excessive hyperglycemia.

Then would lead to bladder problems and infections in the bladder with cystitis. Could lead to sexual dysfunction and other problems.

Pt's HgA1C is an 8 and glucose level is at 148 which means poor regulation of glucose levels leading to open angled glaucoma from optic nerve changes

HgA1C is at 8 showing long term elevated sugar levels because of poor diet or malnutrition

Resulting in elevated glucose levels up to 148 by attaching themselves to Hgb

BUN level is at 29 and creatine is at 1.3 is on the higher side which may indicate malnutrition along with diminished kidney function

A low wbc may indicate malnutrition or in-proper use of medications that lead to improper healing of foot ulcer (which is seen by George and his labs with WBC count)

Hydrochlorothiazide for patient's hypertension--transported from the circulation into epithelial cells of the distal convoluted tubule by the organic anion transporters OAT1, OAT3, and OAT4.

Metformin for patient's diabetes. Metformin : decreases blood glucose levels by decreasing hepatic glucose production (also called gluconeogenesis), decreasing the intestinal absorption of glucose, and increasing insulin sensitivity by increasing peripheral glucose uptake and utilization. : :

Clindamycin (antibiotic) works primarily by binding to the 50s ribosomal subunit of bacteria. This agent disrupts protein synthesis by interfering with the transpeptidation reaction, which thereby inhibits early chain elongation.

Furosemide promotes diuresis by blocking tubular reabsorption of sodium and chloride in the proximal and distal tubules, as well as in the thick ascending loop of Henle.

Signs and symptoms include: Spontaneous pain like Shooting, burning, stabbing, or electric shock-like pain; tingling, numbness, or a “pins and needles” feeling. Evoked Pain: Pain brought on by normally non-painful stimuli such as cold, gentle brushing against the skin, pressure, etc

Neuropathic pain is very similar to PAD in the signs and symptoms it presents in as well as this neuropathy can be a very likely cause of PAD. Foot wounds can cause this neuropathy and that can lead to PAD if not treated early enough.

Signs and symptoms of these bladder issues and cystitis: pain, burning, or stinging when you pee, needing to pee more often and urgently than normal, urine that's dark, cloudy, or strong smelling; feeling achy, sick, or tired.

Increased plaque on arterial walls allows for impairment on vessels leading to hypertension and coronary artery disease to develop.

This can interact with the potassium, potentially lowering his potassium serum level. Which could make sense because his K lab came back at a 3.3 mEq/L which is lower than the normal 3.5-5.0 mEq/L

This increase in the release of fat can lead to an increase of plaque on arterial walls which can be released into the blood to in creased LDL and a low HDL in a blood test

High LDL (bad), and a low HDL (good), indicates poor lifestyle choice or improper management of their glucose which can lead to built up plaque on arterial walls leading to hypertension and CAD

Open angle glaucoma manifests in forms of eye pain and pressure, headaches, red eyes, low vision, blurred vision, narrowed vision, or tunnel vision. (George is exhibiting blurred vision)

Treated with prostaglandin analogs like latanoprost, bimatoprost, and travoprost (in George's case latanoprost)

Medication such as statins or specifically Atorvastatin can treat high cholesterol levels and triglycerides levels through inhibiting the enzyme HMG-CaA. This medication could lower LDL and increase HDL

The uses of a diuretic or what some people call a water pill could help decrease the water retention in the body which could lower blood pressure as the amount of water or fluid in the body is decreased

A antihypertension medication such as metropolol is used to lower blood pressure and allow the vessels to constrict or dilate as they once did before.

The use of metformin could be used to help control high glucose levels more preventing the plaque build up on arterial walls.

Metformin will decrease blood glucose, you will watch renal function as well so GFR. You should check for signs of lactic acidosis because that is possible while taking metformin. Watching for signs like confusion, lethargy, stupor, shallow rapid breathing, tachycardia, hypoTN, N/V.